Professional Documents
Culture Documents
TSM Personnel Form
TSM Personnel Form
A. Personal
Manokaran vijayakeerthy M
Birth Date Social Security / Tax Ref
Place of Birth Nationality National Reg. No.
(DDMMYY) Number
9944489994
3/1,6th street gopalakrishna nagar ,vellore-6,Tamil nadu vijayakeerthy@yahoo.co.in
Passport No. Place of Issue Issued Date Expiry Date Civil Status
Schengen Visa No. Place of Issue Issued Date Expiry Date Nearest Int’l Airport
no chennai
B. Next of Kin
Home:0416-2240113
3/1,6th street gopalakrishna nagar ,vellore-6,Tamil Nadu
Cell:9944055106
C. National Certification
D. Bio Data
XL 9
Issued Expiry
Documents Held STCW’95 Flag State Number
STCW IV – Radio
G. Sea Service Record (Note: Sea service should be listed in chronological order with most recent assignment first and
should include details for the past 5 years as a minimum)
Engine Period
T (DD/M
y M/YY)
p
Vessel DWT / Length of Ship
Rank Vessel Name e
/ From To
K
W
C/E ALMYROS Bulk 56768 MAN B&W 31-07- 22-11- Dynocom
Carrier 6S60MC-C 18 18 3M25D
2007
I would like to apply for a position on below ship types based on my personal preference and
relevant experience (tick as applicable):
TANKERS
Ship
Ship size Tick if Tick if
Ship type Ship type size
(DWT) Applicable Applicable
(DWT)
Very Large Crude Carrier 160K+ ☐ Asphalt & Bitumen Carrier ALL ☐
Chemical Tanker
ALL ☐ LPG ALL ☐
(Hard Core Chemicals)
Chemical Tanker
ALL ☐ LNG ALL ☐
(Soft / Easy Chemicals)
DRY BULK
Ship
Ship size Tick if Tick if
Ship type Ship type size
(DWT) Applicable Applicable
(DWT)
I hereby certify that the information given above are true and correct to the best of my knowledge and belief
and that I have not withheld any information that would affect my application unfavourably.
Any false declaration I supplied herein may constitute ground for disqualification and non-acceptance to the
company and can be further subjected to applicable penalties in accordance to existing laws governing the
recruitment and employment of overseas seafarers.
Annex 1:
CARGO EXPERIENCE INFORMATION SHEET – TANKERS
Instruction to Applicant: Please tick appropriate box for cargoes that you have been carried before.
ASPHALT YES
(Note: Experience with any 1 of the listed cargoes NO
is required for asphalt tanker assignment) As Rating As Jr Officer As Sr Officer
ASPHALT
BITUMEN
COAL TAR
RESIDUAL OIL
GAS YES
(Note: Experience with any 2 of the listed cargoes NO
is required for gas tanker assignment) As Rating As Jr Officer As Sr Officer
AMMONIA, ANHYDROUS
BUTADIENE
BUTANE
BUTANE-PROPANE MIXTURES
BUTYLENES
ETHANE
ETHYLENE
MIXED C4
PENTANES
PENTENE
PROPANE
PROPYLENE
PROPYLENE OXIDE
VINYL CHLORIDE
OTHER INFORMATION /
NO YES COMMENTS
AREAS OF KNOWLEDGE
CRUDE OIL WASHING
DEEP WELL PUMP EXPERIENCE
SPECIALISED FRAMO COURSE
TANK COATING – PHENOLIC EPOXY
TANK COATING – EPOXY
TANK COATING – ZINC PAINT
TANK COATING – STAINLESS STEEL
TANK COATING – MARINELINE
ANY OTHER RELEVANT INFORMATION THAT YOU WOULD LIKE TO INFORM US ABOUT:
Annex 2:
CARGO EXPERIENCE INFORMATION SHEET – DRY BULK
Instruction to Applicant: Please tick appropriate box for cargoes that you have been carried before.
YES
DRY BULK NO
As Rating As Jr Officer As Sr Officer
GRAIN & AGRICULTURAL PRODUCTS yes
COAL yes
ORE yes
STEEL & STEEL PRODUCTS yes
TIMBER
LOGS
REEFERS
yes
(Container Vessels Only)
IMDG
yes
(Container Vessels Only)
OTHERS
(please specify below):
OTHER INFORMATION /
NO YES COMMENTS
AREAS OF KNOWLEDGE
GEARED VESSEL EXPERIENCE
IHI, MITSUBISHI
(if yes, please specify what kind of cranes)
TYPES OF HATCH COVERS
(please specify)
ANY OTHER RELEVANT INFORMATION THAT YOU WOULD LIKE TO INFORM US ABOUT: